Battling America's bad habits

It's fair to say that most public-health officials in this country are at war with America's worst habits and instincts. That's a long list.

But on at least two fronts, they're winning: seat belts and smoking.

First, seat belts. The good news is that the federal government's national "Click It or Ticket" ad campaign is being credited for increasing belt use by those most resistant--people aged 16 to 24. Usage among those young men rose from 65 percent to 72 percent, while young women increased from 73 percent to 80 percent, according to the U.S. Department of Transportation. That was a larger increase than in the population as a whole, which registered a four percentage-point rise, to 79 percent.

Of course, it's probably not the ads but the prospect of a traffic ticket that is motivating most people.

Still, the big question: What about the sizable numbers of people who resist? What planet are they living on? Buckling up is easy, compared to quitting smoking--or just about anything else. It doesn't cost anything except a few seconds of your time. Yet millions of drivers still don't do it. That's frustrating. But progress on these giant public health issues is often slow and lurching.

Not so, it seems, for New York's anti-smoking campaign. In 2002, New York City turned itself into a giant anti-smoking laboratory. That was the year the price of a pack of cigarettes in that city soared to $7.50, double the national average. A few months later came bans on smoking in bars and restaurants. Mayor Michael Bloomberg mounted an aggressive anti-smoking campaign, including advertising and the free distribution of thousands of nicotine patches.

Early results are in, and they are extremely encouraging. The city reports that the number of adult smokers in New York City fell 11 percent from 2002 to 2003--or about 100,000 smokers--one of the steepest short-term declines ever measured, according to the survey. Some cigarette manufacturers and others in the tobacco lobby expressed skepticism about the numbers, suggesting that the survey did not account for factors like smuggling to evade taxes and increased sales of lesser-known brands from small manufacturers.

Still, the evidence from past price hikes is clear that such moves do persuade some people to stop. A tax hike in Cook County has also cut deeply into cigarette sales, county officials reported recently, though they did not tally how many had quit because of it or how many went to the collar counties to buy cheaper cartons.

There's also a continuing dispute about the long-term economic effects of such efforts. Earlier this year, New York City's Health Department reported that its restaurants and bars prospered despite the smoking ban, with increases in jobs, liquor licenses and business tax payments.

But others are skeptical of such conclusions. This page has not supported such blanket laws, preferring instead to allow individual restaurants to decide the best policy. Many have already prohibited smoking, as their clientele demands. That's a healthy trend, for the former smokers and those who worked in smoke-filled restaurants and bars.

Forty years ago the surgeon general declared that cigarettes posed a health hazard to Americans, the first shot in a war that has proven a lot tougher to win than some expected. Some probably thought that with sufficient evidence to show that cigarettes kill, most Americans would do the sensible thing and stop. But for a variety of reasons--not the least of which is that tobacco is incredibly addictive--that hasn't happened.

The rate of smoking among U.S. adults began a steep decline from about 40 percent in the mid-1960s to about 23 percent today. But smoking rates in the U.S. ebbed only minimally in the 1990s. Health experts say those numbers have reached a plateau. And even though a recent survey found that fewer kids are smoking, an estimated 757,000 kids still start every year, the American Lung Association says.

No, the war's not won. These things take time--generations--and the trend is clearly going the right way. "The world is certainly a different place," Tom Glynn, director of cancer science and trends at the American Cancer Society in Atlanta, told a reporter earlier this year. "We've moved from total acceptance of tobacco to a situation where virtually everyone, including smokers, is aligned against it."

It will take more than a generation or two to largely eradicate a nasty habit that has been passed along for hundreds of years. But when smoking is banned in Ireland's pubs, Los Angeles' beaches and in Lexington, Ky., the heart of America's tobacco growing country, well, something's going on.

Life is full of risks. Many are unavoidable. But some, like smoking and failing to buckle up, are not. There will always be some who thumb their noses at common sense and embrace unnecessary risks and bad habits. But the good news is, through a combination of aggressive laws, better public-health information and economic pressure, those numbers seem to be dwindling.